Provider Demographics
NPI:1750600722
Name:POLLARD, KODI ALVINEE' (MA, MHR, CM II)
Entity type:Individual
Prefix:MS
First Name:KODI
Middle Name:ALVINEE'
Last Name:POLLARD
Suffix:
Gender:F
Credentials:MA, MHR, CM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE 122ND ST APT 1808
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8154
Mailing Address - Country:US
Mailing Address - Phone:405-921-0082
Mailing Address - Fax:
Practice Address - Street 1:1330 N CLASSEN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6834
Practice Address - Country:US
Practice Address - Phone:405-812-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK316428171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator